Surgical instrument



March 29, 1960 RATHMANN 2,930,376

' SURGICAL INSTRUMENT Filed May 23, 1958 Jrroeugys,

nited States Patent SURGICAL INSTRUMENT William G. Rathmann, Inglewood, Calif.

Application May 23, 1958, Serial No. 737,357

6 Claims. (Cl. 128-305) The present invention relates generally to surgical instruments, and more especially to an instrument for surgical excision or removal of the prepuce of the female clitoris.

So far as is known, no instrument has been especially designed for this particular operation and is able to perform the operation with maximum ease and freedom from post-operative complications.

Accordingly it is a general object of my invention to provide a surgical instrument of this character which will permit this particular operation to be performed easily and :simply so that the procedure may be made available to all doctors without any special surgical training being required to enable use of this instrument.

A further object of the invention is to provide a surgical instrument especially designed for this particular operation which reduces bleeding to a minimum, enabling the operation to be performed easily and in a minimum.

time.

A further object of the invention is to provide an instrument adapted to this operation which enables the surgeon to make a better balanced and more even type of incision and which insures complete removal of the undesired tissue with the result that healing is facilitated and post-operative care and complications are reduced to a minimum.

These objects and advantages of my invention have been achieved by providing an instrument comprising a pair of pivotally connected levers which include handle means for moving the'free endsof the levers toward and away from each other. Mounted on these free ends of the levers is a pair of cooperating heads, one head being attached to each of the levers so that the heads are movable toward and away-from each other to grip tissue between them; One head has-a substantially planar gripping surface and is preferably imperforate so that the surface is co-extensive with the head. The other head is provided with a central opening of such size that the surrounding portion of the head is reduced to a relatively narrow border that provides a narrow gripping surface, also planar, which coincides in shape and size with the margin of the forward portion of the planar surface on the other head. The opening is for the purpose of admitting a surgical knife for cutting the tissue immediately adjacent said narrow gripping surface so that they to the following description and the annexed drawing in which:

Fig. 1 is a perspective view of a surgical instrument constructed according to my invention.

Fig. 2 is a plan view of the instrument.

Fig. 3 is a side elevation of the instrument, the heads being shown in gripping position as well as in open position.

Fig. 4 is an enlarged bottom plan view of one of the gripping heads, as indicated by line 4-4 in Fig. 3'.

Fig. 5 is an enlarged top plan view of the other gripping head as indicated by line 5-5 in Fig. 3.

Fig. 6 is an enlarged fragmentary vertical section taken through both headsillustrating the shape and location of the tissue gripping area, as shown on line 66 of Fig. 2.

Fig. 7 is a fragmentary vertical section through both heads on line 77 of Fig. 2.

Referring now to the drawing, and more especially to Figs. 1 and 3, it will be seen that the instrument comprises a pair of levers 10 and 12 which are pivotally interconnected by transverse bolt 14. The' primary lever 10,-

which is the upper one when the instrument is in the position of Fig. 1, is a relatively long, straight member while the secondary lever 12, is a shorter, angular member which is connected to the pivot 14 at one end of the lever. The pivot 14 engages lever 10 at a point spaced from the forward end of the lever. At the forward free end of each lever is mounted one of the two heads or jaws which cooperate to grip tissue between them, as will be explained. Head 16 is mounted on upper lever 10 while head 18 is mounted on the lower lever.

Lever 12 is manipulated by means of an, operating member 19 which is pivotally connected at its forward end to lever 12 by pivot "20 which is located intermediate the ends of lever'12. Operating member 19 is also pivotally connected at 22 to the forward end of com 10, is in tension and normally pulls the levers to the open position. The rear portion of lever lfl and operating member 19 provide handle means by which the instrument is held in one hand and heads 16 and 18 are moved toward (or away from) each other.

The construction of the lever and operating member 19 as described above will be recognized as old' in the art of hand tools, but it provides an especially advan tageo'us means for manipulating the gripping heads 16- and 18 which are of novel design. However, my invention isnot necessarily limited to levers and-an operating member of the design illustrated.

The surgical instrument is ordinarily held in one hand with lever 10 uppermost and accordingly it is referred to as the upper lever. Similarly, other references to relative directions are based upon the position of the instrument as shown in Fig. 1; and'it will be realized that these references are for descriptive purposes only and are in no way limitative upon the invention. When in this 'position, if the operating member 19 is lowered to the open or dot-dash position shown inFig. 3, the two cooperating heads 16 and 18 are separated. They may be brought together bymoving the'operating handle upwardly to the full line position. As the handle moves upwardlyfthe forward end of compression link 23 swings upwardly in a clockwise direction around pivot 24, thus causing the forward end of operating member 19 to move forwardly.

This carries pivot 20 in a clockwise direction around pivot The shapes of levers and 12 'are such that the two opposing surfaces on cooperatingheads 16 and 18 are substantially parallel and are moving in a direction substantially perpendicular to each other as they approach engagement. They can actually engage; but their travel is ordinarily limited to positions short of engagement, even when no tissue is between them, by means of adjusting screw 26. When screw 26 is turned in adirection to move pivot 24 forwardly, the heads 16 and 18 arebrought closer together at the end of the travel ofhead 18. Turning screw 26 in the reverse direction increases the ultimate spacing. The linkage provides an. over-center type of lock which holds the'heads fixed relative to eachother when they are in the gripping position, shown in Figs. 1 and 3. This is accomplished by locating pivot 22 substantially in a line connecting pivots 20 and 24 when the heads 16 and 18 are closed.

In shape, the two heads 16 and 18 are generally triangular in outline. They taper forwardly to a blunt point at the forward end. They are both of the same general shape; but as may be seen from Figs. 3 and 6, the upper head 16 is preferably slightly larger in overall dimensions than the lower head, as a result of design for maximum strength.

The lower head is shown in plan in Fig. 5. It is generally a thin, plate-like member having a planar upper surface 18a co-extensive with the size of the head. However, apart from the marginal gripping portion this upper surface may have other-shapes if desired. Likewise, the lower head is preferably imperforate; but this is not necessarily so. Viewed in profile, it will be seen that the lower head is relatively thin and that the sides are beveled or tapered inwardly and downwardly so that the head has its maximum dimensions at its upper surface. A thin plate of this outline has been found preferable for the lower jaw. A thin plate, especially at the edges is advantageous for allowing entry between the clitoris and the prepuce; yet the plate is thick enough to have the necessary mechanical strength to resist bending, especially at the forward end.

The upper head 16 is also a plate-like member and has a relatively large central opening 28. The edge of this opening substantially parallels the outer'edge of the head along the front half, more or less, of the two forwardly converging sides. Thus the gripping surface on the forward portion of head 16, is limited toa relatively narrow surface 16b (Figs. 4 and 6) which conforms to the margin of the forward portion of surface 18a on the lower head 18., Surface 16b, lies in a plane in order to engage evenly with surface 18a. .These areas of the opposing surfaces on the two heads are operative to engage and grip between them the prepuce during the operation.

The inner surface 16a defining opening 28 of the upper head is preferably substantially perpendicular to' the upper surface 18a of the lower head. The lower corners of the upper head at the intersection of surface 16a with the narrow gripping surface 161) is relatively angular rather than rounded. Gripping surface 16b of the upper head is made relatively narrow in orderto limit the'area over which tissue is engaged, for reasons; that will be explained.

In perfo'rmin'g'the operation, theprepuceis first freed from the clitoris by blunt dissection. Next. the lower head 18 of the instrument isplaced under theprepuce.

By reaching through opening 28 in the upper head, the

desired amount of prepuce can be pulled through the opening to control the amount of excess tissue to be removed. Next the two heads are brought together by manually applied pressure on the handle portions o f lever 10 and member 19 to clamp the prepuce between the heads. Since opposing surfaces 18a and 16b are parallel issuers to each other in gripping position, pressure is applied evenly to the prepuce tissues over the full area of engagement. The final clearance between the heads is adjusted by turning screw 26 to accommodate different thickness of tissue. This final clearance determines the magnitude of the applied pressure.

The prepuce is held tightly clamped between the two a gripping heads for a period of several minutes, typically about five minutes, prior to cutting away the excess tissue. When the surface 16b is of optimum Width, it has been found that leaving the tissues clamped for a period of approximately five minutes, more or less, produces hemostasis in these tissues and as a result there is little of no bleeding after the excess tissues are cut away. If the area 16b is made about .025 to .O30inch in width it has been found that a satisfactory degree of hemostasis is produced. A narrower gripping surface is liable to cut the tissues, which is harmful. Likewise, if the gripping area is made substantially wider the pressure per unit area upon the tissues may not be sufliciently great to reduce circulation in them to the desired degree and as a result there is excessive bleeding. While the optimum width is 0.25 to .030 inch, some departure is practical provided the applied unit pressures are closely controlled. When the gripping area is made of the optimum width circulation in the tissue is stopped or reduced to the desired degree but the tissue does not die or is not bruised to the extent that there is any sloughing of tissue in the post-operative period.

In order to maintain the high pressure upon the gripped tissues for a period of several minutes, it is preferable that the instrument include-some suitable means for sustaining this pressure for the desired period of time without tiring the hand of the doctor. It is for this reason that the mechanism for-moving the heads towards each other incorporates locking means for holding the heads in a fixed position relative to each other when they have been brought into the position for gripping tissues, as is providedby the relative. positions of pivots 20, 22, and 24.

After the instrument has been applied for this initial period of several minutes, the excess tissue is removed by inserting a knife in opening 28 in the upper head cutting along the line defined by inner vertical face 16a which is the wall around this opening. By having the wall vertical or substantially perpendicular to the opposing surface 18a of the lower head, face 16a provides aguide=for the surgical'knife. Surfaces 16a and -16b.pref erably in ersect to form a corner-at the bottom of the wall. Consequently the cut is made immediately ad joinin'g-the area .gripped between the heads. Thus the shape of this surface 16a provides a guide which accuratelylocates the line of cutting with respect to the area on the tissue being'held between the two heads.

When viewed in cross-section (Fig. 6), it will be seen that at the two longer sides of central opening 28 the upper head is wider at the uppersurface of the head than at the lower. This is done in order to provide extra metal where'it'can best reinforce the head without many way interfering with the proper gripping action. This reinforcement is desirable in order to keep the forward end of the upper head from deflecting away from. the lower head when gripping pressure is applied and thus not providing adequate pressure upon tissue held between the 'tw'oheads.

in the size or shape or detailed arrangement of the parts may occur to persons skilled in the art withoutdepare' 7 ing from the spirit and scope of my invention. Accordingly it is to be understood that the foregoing description is considered as being illustrative of rather than limitative upon the invention as defined by the appended claims.

I claim: 1. A surgical instrument of the character described, comprising:

A pair of pivotally connected levers including'handle" means for swinging the levers toward each other;

A pair of'cooperating heads attached one to each lever and movable toward each other to grip tissue between them, one head having over its full extent a substantially planar gripping surface and the other head having a central opening surrounded by a narrow planar gripping surface conforming to the outline of the forward portion of the first mentioned planar surface, said opening admitting a knife for cutting tissue immediately adjacent said narrow gripping surface; and means for adjustably limiting the travel of said heads toward each other to limit the pressure applied to tissue gripped between them.

2. A surgical instrument for hemostatic' circumcision of females, comprising: a pair "of pivotally connected levers;

Means for swinging the levers toward and away from opening admitting a. knife to cut tissue adjacent said i narrow gripping surface, said narrow surface being sufficiently narrow to produce hemostasis in tissue gripped between it and the surfaceson the other head.

be'maintained.

4. A surgical instrument as in claim 2 in which the; surface on said other head inside the central opening therein extends away from the narrow gripping surface at substantially a right angle thereto and .v to the planar I surface on the first mentioned head to provide a guide 7 for a surgical knife adjoining and conforming to the area A pair of cooperating heads attached one to each lever and movable toward each other to grip tissue of the prepuce between them, one head having over its full' extent a substantially planar surface and the other head applied.)

of hemostasis. g 5. A surgical instrument as in claim 2 in which both vheads taper forwardly to a blunt point.

" 6. A surgical instrument "as inclaim 2 in which the narrow gripping surface is about .025 to .030 inch wide.

References Cited inthe file oft his patent UNITED STATES PATENTS 2,731,932 Peterson .lan. 24.11956 FOREIGN PATENTS 184,285 7 France. June 17 1887 OTHER REFERENCES Stofz (Catalogue of Instruments), copyright'i193 7, Storz Instrument Co., 1937. (Copy in Div. page 14 

